Manifestations of dysbiosis in the oral cavity in children

What is dysbiosis

Contrary to popular belief, dysbiosis is not an independent disease.
There is no such diagnosis in the International Classification of Diseases, Tenth Revision (ICD-10). It would be more correct to say that dysbiosis, or dysbiosis, is a condition accompanied by an imbalance of intestinal microflora, which occurs as a consequence of other diseases or as a result of treatment with antibiotics. The risk group primarily includes newborns and infants. The fact is that at birth their digestive tract is sterile, which means that there is no microflora as such in it yet. Bifidobacteria and lactobacilli enter the child's body along with mother's milk. However, if a woman was treated with antibiotics during pregnancy, breastfeeding may worsen the situation.

This group also includes patients who have suffered severe illnesses accompanied by exhaustion of the body, infection, hematopoietic disorders or malignant neoplasms. Those people who are subject to frequent stress and bad habits are also at risk.

Complications

The most serious consequences can be caused by the following complications of dysbacteriosis:

1. Losing weight. Progressive weight loss due to malabsorption is common in chronic dysbiosis. In some cases, patients become malnourished as a result of diarrhea. Regardless of the mechanism of exhaustion, the important thing is that the body weakens and becomes more susceptible to other diseases (acute respiratory diseases, chronic diseases worsen). Gaining body weight after prolonged dysbacteriosis is a slow process. More often, severe exhaustion is observed in children with severe forms of the disease.
2. Dehydration. This complication is rare and occurs only in some severe types of dysbacteriosis. The fact is that long-term loss of water as a result of diarrhea can have very serious consequences for the body. Typically, dehydration is said to occur when there is a loss of 3% fluid or more. With a loss of 12% of fluid, the patient's condition becomes very serious and there is a high risk of life. Prolonged diarrhea with pronounced water loss is usually a consequence of the addition of dangerous pathogens that are not normally found in the intestines.
3. Parasitic diseases. To a lesser extent, normal microflora protects the body from some parasitic diseases. We are talking about various helminthiases that are often found in children.
4. Secondary intestinal infections. There are a large number of dangerous intestinal infections that do not affect the body, partly due to the presence of normal microflora. If this line of defense weakens, the likelihood of severe intestinal diseases increases. The most common infections that can aggravate dysbacteriosis and pose a threat to life are salmonellosis, shigellosis (dysentery), cholera, yersiniosis, etc. These diseases pose the greatest danger to children.
5. Developmental disorders in children. In young children, dysbiosis without adequate treatment often becomes protracted. Because of this, the child may lack certain nutrients or vitamins for a long time. Given the high rate of growth and development in early childhood, such problems lead to delays in mental and physical development. Proper treatment can usually correct this deficiency in a child.
6. Inflammatory processes. In rare cases (usually in the presence of concomitant inflammatory bowel diseases), serious changes in the microflora can lead to the development of an inflammatory process in the abdominal cavity. It is believed that chronic dysbiosis plays a role in the development of appendicitis, diverticulitis (inflammation of a diverticulum - a protrusion of the intestinal wall), and the formation of abscesses. Any inflammation in the abdominal cavity is potentially a very dangerous condition and requires intensive treatment (often surgical).

Considering the lack of vitamins and weakened immunity that occur with dysbiosis, there is a risk of other complications that are not directly related to disorders of the intestinal microflora. In general, we can say that dysbiosis is not a dangerous disease, but you still shouldn’t start the disease.

How dangerous are pathogenic microflora?

The human intestine is inhabited not only by obligate bacteria, but also by opportunistic bacteria. If the former are considered a “useful” segment of the intestinal microflora, ensuring normal digestion and supporting immunity, then the situation with opportunistic microbes is more complicated. Under normal conditions, such bacteria do not manifest themselves in any way, but when the natural balance shifts, when their number begins to predominate, a complex of symptoms arises, which is called intestinal dysbiosis.

Representatives of obligate microflora include:

• bifidobacteria;
• lactobacilli;
• propionobacteria;
• Escherichia coli (non-invasive Escherichia).

Representatives of opportunistic flora:

• staphylococci;
• streptococci;
• bacteroides.

There are also pathogenic bacteria (for example, salmonella, yersinia, vibrio cholerae) that are absent in the intestines of a healthy person. However, they can get there by drinking contaminated water or poorly washed food.

A shift in the healthy balance of intestinal microflora and the activity of pathogenic bacteria can be fraught with a number of unpleasant consequences. For example, disruption of the normal biocenosis can contribute to the production of carcinogenic metabolites and the development of malignant neoplasms.

Chronic inflammatory processes accompanying dysbiosis can lead to the development of chronic colitis and enteritis. The danger of the spread of inflammatory processes to the joints cannot be ruled out. Another complication of dysbiosis is a decrease in immunity - a person becomes more susceptible to bacterial and viral diseases.

Other possible complications:

• Hormonal imbalance.
• Premature aging.
• Diseases of the cardiovascular system.
• Sensitization of the body (tendency to allergic reactions).
• Development of atherosclerosis.
• Disorders of the nervous system.
• General weakness and increased fatigue.

Normal microflora

This focus on the tiny inhabitants of the human intestine is explained by the fact that these microorganisms have an extremely positive effect on health. They have many beneficial functions. So, beneficial microflora:

• protect the intestinal mucosa from infectious agents, allergens, and excess opportunistic microbes;
• synthesizes vitamins (especially group B), antitumor substances, enzymes for the breakdown of proteins and sugars;
• neutralizes toxins and harmful metabolic products;
• reduces cholesterol;
• activates immunity:
• produces short-chain fatty acids, which ensure the integrity of the colonic mucosa;
• stimulates the absorption of necessary substances (water, iron, calcium, gases, vitamins E, D).

In addition to beneficial microbes (bifidobacteria, lactobacilli, etc.), opportunistic microorganisms (Klebsiella, Proteus, staphylococci, atypical Escherichia, Serracia, Enterobacter, yeast-like fungi, etc.) live in the intestine. In a healthy person, their number is strictly limited, so they do no harm. But when immunity drops, after intestinal infections, stress, etc. these insidious bacteria and fungi are activated, begin to multiply and have adverse effects, leading to clinical symptoms.

Reasons for the development of dysbiosis

There are a lot of factors that provoke the development of dysbiosis - from regular stress to unfavorable environmental conditions. The most common reasons:

• Use of antibiotics. Antibacterial drugs (especially broad-spectrum) destroy not only pathogenic, but also beneficial microflora.
• Hormonal therapy. This also includes diseases accompanied by changes in hormonal levels. For example, with excess testosterone in women, the balance of intestinal microflora is disrupted.
• Chemotherapy. This radical method of combating metastases produces many unwanted complications, including disruption of the healthy balance of microflora.
• Frequent use of enemas. With regular use of cleansing enemas, beneficial microflora is washed out of the intestines. The greater the volume and frequency of enemas, the more pronounced the manifestations of dysbiosis will be.
• Stress. The microbiota communicates with the brain through the vagus (vagus nerve). Bifidobacteria and lactobacilli themselves are capable of synthesizing acetylcholine, norepinephrine and serotonin. These neurotransmitters are responsible for the psycho-emotional state of a person. At the same time, a reverse relationship is also observed: regular stress suppresses the growth of these bacteria.
• Bad habits. Alcohol and nicotine have a detrimental effect on obligate microflora.
• Poor nutrition. This issue causes controversy among experts. Some are inclined to believe that the role of malnutrition in the development of dysbiosis is overestimated. Others insist that in the absence of a sufficient amount of fiber and lactic acid products in the diet, the healthy balance of microflora is disrupted. Moreover, the situation can be aggravated by a combination with regular consumption of food containing antibiotics, preservatives and other xenobiotics.
• Weakening of intestinal motility. This factor provokes the growth of pathogenic microflora.
• Injuries and inflammations. Any violation of tissue integrity and inflammatory processes weaken the immune system, which affects the biocenosis of the intestinal microflora.

Figure 1. Memo - the main signs and causes of dysbiosis. Source: MedPortal

Causes

Dysbacteriosis does not necessarily develop in people with health problems. Quite often, the problem can appear in adults and children who have never previously experienced any problems with the digestive system.

The main reasons for the development of dysbiosis may be the following:

1. Incorrect use of certain medications;
2. Sudden change in food type;
3. Eating poor quality food;
4. Lack of fortified and fermented milk foods in the diet;
5. Recent intestinal infections;
6. Frequent use of antibiotics;
7. Insufficient protection of the immune system;
8. Having acute or chronic diseases - gastritis, pancreatitis, etc.

At the initial stages of development, dysbiosis may practically not make itself known. A person may only occasionally suffer from minor abdominal pain, bloating, and rare stool disorders.

Kinds

The division of dysbiosis into types is not entirely correct. This condition is classified according to severity according to the criteria proposed by Doctor of Biological Sciences I.B. Kuvaeva and Doctor of Medical Sciences K.S. Ladodo.

Stage 1: the titer of lactic acid flora is reduced by no more than 20% of the norm. The number of bacteroides, as well as lacto- and bifidobacteria, decreases. In some cases, there is an increase in various representatives of opportunistic flora. As a rule, there are no noticeable disturbances in the gastrointestinal tract, which is why this stage is also called latent.

Stage 2: the so-called start-up phase. The proliferation of opportunistic microflora is increasing, the number of Proteus and Candida fungi is growing. At the same time, there is a pronounced tendency towards a decrease in bifidobacteria and other obligate microflora. The degree of intestinal dysfunction is assessed as mild.

Stage 3: aggression phase. Against the background of a rapid decrease in the number of lactobacilli and bifidobacteria, the growth of pathogenic gas-forming microflora progresses. There is an accelerated proliferation of Proteus, Staphylococcus aureus, as well as fungi of the genus Candida. Clinical manifestations are more pronounced.

Stage 4: phase of associated dysbacteriosis. Bifidobacteria at this stage may be completely absent, which leads to severe digestive disorders and the inability to absorb food normally.

The titer of opportunistic microflora reaches a high level, so much so that this essentially turns it into pathogenic. However, this phase occurs only in exceptional clinical situations (for example, while taking antibiotics in combination with hormonal and/or radiation therapy).

As for the classification of dysbiosis according to the localization of the pathological process, it is incorrect, since the process affects any segment of the large and small intestine.

Dysbacteriosis of the small intestine

As mentioned above, dysbiosis affects all parts of the intestine, so this definition is not entirely correct. However, there is a so-called small intestinal contamination syndrome. According to the concept of A. N. Mayansky, this syndrome is caused by the influence of pathogenic microflora on the absorption of fatty acids in the small intestine, which leads to impaired lipid absorption. This process, in turn, promotes the growth of pathogenic microflora, forming a vicious circle.

Dysbacteriosis of the large intestine

If in Soviet times some domestic doctors used such a definition, now, for the reasons described above, it is not considered correct. The most commonly used definition is “bacterial overgrowth syndrome.”

Prevention

The most important method of prevention is timely and rational antibacterial therapy. In this way, the patient can protect himself from the symptoms of dysbiosis and the development of the disease.

A common case of dysbacteriosis is long-term use of antibiotics. To prevent the disease, it is recommended to take the following measures:

• eat fermented milk products;
• start using antifungal drugs;
• take probiotics, multi-enzymes and multivitamins.

The complex of drugs must be prescribed by a doctor; it is not recommended to use any medications on your own.

Symptoms of intestinal dysbiosis

The severity of symptoms of intestinal dysbiosis largely depends on the stage of this condition.

Stage 1. Periodic alternation of diarrhea with stool retention, uneven coloring of stool, increased gas formation, decreased appetite.

Stage 2. Increased flatulence, constipation and diarrhea also become more pronounced. Belching, abdominal pain of undetermined localization, heartburn. Skin rashes may occur.

Stage 3. The listed dyspeptic disorders intensify, the frequency of episodes of diarrhea can reach 4-5 times a day. At this stage, non-healing skin ulcers appear.

Stage 4. The listed symptoms are accompanied by manifestations of intoxication: nausea, vomiting, increased body temperature and general weakness. Mucus may appear in the stool.

Figure 2. Memo - symptoms of dysbiosis. Source: MedPortal

When to see a doctor?

If digestive disorders do not go away within a few days, you should consult a gastroenterologist. Skin rashes or previously uncharacteristic allergic symptoms should cause particular concern. It is better not to delay a visit to the doctor, because the later the causes of this condition are identified, the more time it will take to eliminate it.

Probiotics

Probiotics (eubiotics) are preparations containing live microorganisms (i.e. bacteria of normal intestinal flora), they are used to treat grade 2-4 dysbacteriosis.

1. 1st generation drugs: Bifidumbacterin, Lifepack probiotics. They are liquid concentrates of lactobacilli and bifidobacteria and are not stored for long (about 3 months). This group of drugs is unstable under the influence of gastric juice or enzymes of the gastrointestinal tract, which leads to their rapid destruction and the intake of insufficient concentrations, the main disadvantage of 1st generation probiotics. Bifidumbacterin is prescribed orally, 5 doses of the drug 2-3 times a day, 20 minutes before meals;
2. 2nd generation drugs: Baktisubtil, Flonivin, Enterol. They contain spores of bacteria of normal intestinal flora, which in the patient’s intestines secrete enzymes for the digestion of proteins, fats and carbohydrates, stimulate the growth of bacteria of normal intestinal flora, and also suppress the growth of putrefactive flora. Subtil is prescribed 1 capsule 3 times a day, 1 hour before meals;
3. 3rd generation drugs: Bifikol, Linex. They consist of several types of bacteria from the normal intestinal flora, and therefore are highly effective compared to the previous 2 generations of probiotics. Linex is prescribed 2 capsules 3 times a day;
4. 4th generation drugs: Bifidumbacterin forte, Biosorb-Bifidum. This group of drugs consists of bacteria of normal intestinal flora in combination with an enterosorbent (with activated carbon or others). Enterosorbent is necessary to protect microorganisms when passing through the stomach, it actively protects them from inactivation by gastric juice or enzymes of the gastrointestinal tract. Bifidumbacterin forte is prescribed 5 doses 2-3 times a day, before meals.

Treatment of intestinal dysbiosis is prescribed comprehensively depending on the degree of the disease. Since dysbiosis develops under the influence of many factors, it is important to eliminate the cause of its development, otherwise taking probiotics will not have a positive effect. Elimination of foci of infection and chronic diseases is the main task in the treatment of dysbiosis.

Diagnosis of intestinal dysbiosis

The appearance of even 1-2 of the above symptoms should be a cause for concern and contact a gastroenterologist. It should be understood that diagnostics will be aimed not so much at identifying dysbiosis, but at searching for possible causes and complications of primary diseases that contributed to its development.

Typically, the doctor uses screening and differential diagnostics aimed at identifying diseases of the intestines and liver (nonspecific ulcerative colitis, irritable bowel syndrome, colon cancer, hepatitis of various origins).

Direct indications for studying the state of intestinal microflora are:

• Long-term course of intestinal disorders.
• Prolonged recovery period after infectious diseases or surgical interventions.
• Dyspeptic disorders due to the use of antibacterial drugs or regular contact with them (at work or among medical staff).

The following methods are used directly to diagnose dysbiosis:

• coprogram;
• bacteriological examination of biopsy or small intestinal juice;
• gas chromatography and mass spectrometry;
• breath test to determine hydrogen content.

During a coprological study, the number of bifidobacteria, lactobacilli, enterobacteria, E. coli, as well as representatives of opportunistic microflora (Staphylococcus aureus, Pseudomonas aeruginosa, Proteus, fungi of the genus Candida, etc.) is determined. However, the richness and variability of the composition of the intestinal microflora does not make it possible to obtain a complete picture of changes in the intestinal microbiocenosis. Therefore, from the point of view of modern medicine, stool analysis is considered an outdated method.

Usually preference is given to more modern diagnostic procedures—gas chromatography combined with mass spectrometry.

Chronic dysbacteriosis

Chronic dysbacteriosis is somewhat less common. At the same time, disturbances in the composition and quantity of microflora do not return to normal for a very long time (months, years). As a rule, there are prerequisites that do not allow normal microflora to recover. However, in most cases, this problem can still be solved with proper treatment.

In the chronic course of dysbacteriosis, it is important to pay attention to the presence of the following factors:

• self-medication and unqualified treatment;
• weakened immune system;
• chronic inflammatory bowel diseases;
• non-compliance with the prescribed diet;
• presence of intestinal tumors;
• the presence of a constant source of infection (poor quality drinking water, etc.);
• possible resistance of bacteria to prescribed antibiotics (checked by antibiogram);
• chronic diseases of the liver, pancreas, stomach.

In the presence of the above factors, the prerequisites are created for changes in the composition of the intestinal microflora. If these factors are not eliminated, treatment in most cases will not have the desired effect. The disease takes a chronic course.

Treatment of intestinal dysbiosis in adults

Contrary to the stereotypes imposed by commercials, taking probiotics does not solve the problem at the root. It is necessary first of all to find and eliminate the cause of dysbiosis, since the phenomenon itself is secondary.

Treatment of intestinal dysbiosis should be based on the following principles:

• Elimination of external risk factors (correction of nutrition, drinking clean water, minimizing contact with harmful substances, and so on).
• Suppression of excessive growth of opportunistic microflora.
• Taking probiotics and prebiotics.
• Consolidating a positive result and achieving stable remission.

Let's take a closer look at all these principles.

Diet

Source: freepik.com/poringdown
Proper nutrition plays an important role in stabilizing the microbiocenosis of the intestinal microflora. Therefore, treatment should begin with diet correction. It is necessary to reduce the consumption of foods that cause fermentation processes (or even better, completely abandon them). This also applies to products that are not recommended for consumption for chronic gastrointestinal diseases. The reason for this is that, as we already know, dysbiosis is always secondary to the underlying disease, such as colitis, gastritis or hepatitis.

Improper nutrition provokes exacerbation of diseases of the liver and gastrointestinal tract, which will aggravate the imbalance of intestinal microflora. Therefore, without correcting the diet, all attempts to combat dysbiosis are doomed to failure.

Much attention should be paid to fiber - dietary fiber stimulates intestinal motility and absorbs toxins. In fact, fiber is a prebiotic, since the obligate intestinal microflora uses dietary fiber as a nutrient medium.

Medications

Before moving on to the description of medications used for dysbiosis, we emphasize that first of all it is necessary to treat the underlying disease. This is called etiological treatment - influencing the cause, not the effect, of the disease. As for drugs used directly to eliminate dysbiosis, they can be divided into several groups.

Antibiotics

The use of antibacterial drugs is advisable in case of excessive growth of pathogenic microflora in the intestine, which is accompanied by a deterioration in the functional state (impaired motility and absorption). The following groups of antibiotics are used:

• penicillins (amoxicillin);
• fluoroquinolones (ofloxacin, norfloxacin);
• tetracyclines (doxycycline);
• broad spectrum (rifaximin).

The average course of treatment is 7 days.

Probiotics

Expert opinions regarding the effectiveness of these drugs are contradictory. Many domestic gastroenterologists consider the administration of probiotics to be an integral part of the fight against dysbiosis, however, in foreign clinical practice, the advisability of using these drugs is now increasingly criticized. Opponents of the use of probiotics argue their position by the fact that most of it simply does not take root in the patient’s body. There are also opinions that the use of these drugs may contribute to the growth of fungal infections in the blood.

The basis of the composition of probiotics is represented by lacto- and bifidobacteria, but Escherichia, streptococci and enterococci can be used as a supplement. Probiotic release form:

• capsules;
• powders;
• drops;
• rectal suppositories (suppositories).

Drugs to improve digestion

This includes pancreatic enzymes (pancreatin and drugs containing it), as well as drugs to improve intestinal motility (domperidone, metoclopramide). In addition, to normalize the intestinal absorption function and improve the functional state of the liver, hepatoprotectors (phospholipids, preparations with milk thistle extract) are prescribed.

Folk remedies

Here it is important to determine the interpretation of this definition in the context of eliminating dysbiosis. For example, some consider the consumption of fermented milk products or sauerkraut as a folk method of treating dysbiosis, although in fact this is only one aspect of normalizing the diet.

As for decoctions of medicinal herbs or yeast infusions, which are used both for oral consumption and for microenemas, it is better not to use such methods without the consent of a doctor. Often such remedies do more harm than good.

Diagnostics

In order to determine the presence and nature of dysbiosis, it is necessary to find out which microbes populate the intestines and in what quantity. Today, two main diagnostic methods are practiced:

1. The method for examining microflora metabolites is based on determining the substances (volatile fatty acids) that microbes secrete during their development. This method is highly sensitive and easy to determine microbes and allows you to get results within a few hours. In addition, it is not as expensive as bacteriological.
2. Bacteriological research. With the bacteriological method, depending on the specialization of the laboratory, from 14 to 25 species of bacteria are determined (this is only 10% of all microorganisms). Alas, you will receive the result of this analysis only after 7 days; on average, this is the time it takes for bacteria to grow in special nutrient media and be identified. In addition, the quality of the results of this analysis also depends on compliance with delivery times and the quality of the material; there are also difficulties in cultivating certain types of bacteria.

It must be remembered that the composition of the intestinal microflora is individual for each person. It depends on age, food consumed, and even the time of year. Therefore, making a diagnosis based solely on tests is a mistake. Additional examination is needed to determine the cause of dysbiosis.

Treatment prognosis

Microflora has a remarkable property: it recovers on its own even after taking antibiotics. Therefore, the most important thing is to create favorable conditions for its restoration (we talked about them in the previous sections of the article). Thus, the prognosis for dysbacteriosis is positive. At the same time, it is important to understand that under unfavorable circumstances (exacerbation of chronic diseases, poor lifestyle, violation of healthy eating rules, etc.), the re-development of dysbiosis cannot be ruled out.

Can the patient do without treatment?

Cases of independent voluntary disposal of minor disturbances in the intestinal microflora are recorded quite often in medical practice. But most of these examples are associated with disorders due to emotional shocks or rapid acclimatization.

Please note that dysbiosis can stop progressing only in the first phase of its development. This is the big problem, because during this period it is almost impossible to notice characteristic changes in the intestinal microflora. And if the patient already has pronounced symptoms of the disease, then he needs medical help, since we are talking about a seriously advanced process.

Prevention of intestinal dysbiosis

To avoid excess microbial growth in the intestines, just follow a few simple recommendations.

• Observe hygiene rules when preparing and eating food. You should also avoid drinking poorly purified water.
• Maintain physical activity. A sedentary lifestyle has a bad effect on intestinal motility, and this, in turn, leads to constipation and the associated processes of fermentation and growth of pathogenic microflora. Any type of exercise is suitable - from walking to working out in the gym. The load should be selected in accordance with the age and functional capabilities of the body. The most important thing is to avoid physical inactivity.
• Watch your diet. It is important that the menu contains fiber and a sufficient amount of clean drinking water (you should drink based on your own thirst, but usually at least one and a half liters per day is recommended).
• Avoid bad habits and stress.
• Do not self-medicate with antibiotics. The prescription of antibacterial drugs should always be justified, and therefore is the prerogative of the attending physician.

Diet for dysbiosis

How to treat intestinal dysbiosis? With a mild degree of imbalance in the intestinal microflora, it may be sufficient to eliminate these causes through a balanced diet, taking prebiotics or probiotics.

In case of severe disorders, dietary nutrition is also indicated simultaneously with complex antimicrobial therapy. Basic Rules:

1. Products are steamed, boiled, baked, stewed. No frying!
2. Drink plenty of fluids, mostly clean water. For diarrhea, it helps against dehydration, and for constipation, it softens clotted stool.
3. The food is balanced, rich in foods containing proteins, carbohydrates, vegetable fats, minerals, vitamins necessary for the full functioning of the body.
4. Remove foods that irritate the gastrointestinal tract, have a laxative or fixative effect.
5. Avoid products that cause gas formation, fermentation, and rotting.
6. Remove sauces, hot spices, smoked meats, marinades, and strong alcohol. No fast food, semi-finished products, dry food, on the go. Rich broths, confectionery, baked goods, whole milk, strong tea are prohibited.
7. Eat foods that create favorable conditions for the growth of beneficial bacteria. They place emphasis on fermented milk products (kefir, yogurt, acidophilus milk), and foods rich in plant fiber.
8. They refuse fresh vegetables and fruits. Any heat treatment is preferred. Baked apples are an excellent dessert, rich in vitamins and healthy elements.
9. Eat food regularly, every 2.5-3 hours in small portions. Long intervals between meals should not be allowed.
10. The temperature of the food should be pleasant and warm. You can't eat hot, it's too cold.

Diet is an important condition for the successful treatment of dysbiosis in adults and children. Food consumption is not limited, its composition is changed. A balanced diet and properly prepared food will help restore the lack of vitamins, increase hemoglobin, normalize digestion, and ensure complete excretion of bile.

Experts' opinion

Asept products have proven effectiveness. For example, multiple clinical studies have proven that the two-component mouth rinse ASEPTA ACTIVE more effectively combats the causes of inflammation and bleeding compared to single-component rinses - it reduces inflammation by 41% and reduces bleeding gums by 43%.

Sources:

1. The role of anti-inflammatory rinse in the treatment of periodontal diseases (L.Yu. Orekhova, A.A. Leontyev, S.B. Ulitovsky) L.Yu. OREKHOVA, Doctor of Medical Sciences, Prof., Head of Department; A.A. LEONTIEV, dentist; S.B. ULITOVSKY, Doctor of Medical Sciences, Prof. Department of Therapeutic Dentistry of St. Petersburg State Medical University named after. acad. I. P. Pavlova
2. Report on clinical trials to determine/confirm the preventive properties of commercially produced personal oral hygiene products: mouth rinse "ASEPTA PARODONTAL" - Solution for irrigator." Doctor of Medical Sciences Professor, Honored Doctor of the Russian Federation, Head. Department of Preventive Dentistry S.B. Ulitovsky, doctor-researcher A.A. Leontiev First St. Petersburg State Medical University named after academician I.P. Pavlova, Department of Preventive Dentistry.
3. Report on determining/confirming the preventive properties of commercially produced personal oral hygiene products: Asepta toothpaste used in combination with Asepta mouthwash and Asepta gum balm Head. Department of PFS Doctor of Medical Sciences Professor S.B. Ulitovsky St. Petersburg State Medical University named after Academician I.P. Pavlova. Faculty of Dentistry. Department of Preventive Dentistry.